经皮后路短节段椎弓根螺钉固定结合伤椎强化治疗单节段胸腰椎骨质疏松性骨折

目的 :探讨经皮后路短节段椎弓根钉固定结合伤椎骨水泥强化治疗单节段胸腰椎骨质疏松性骨折的临床疗效。方法:2009年1月至2013年1月采用经皮后路短节段椎弓根螺钉内固定结合伤椎骨水泥强化治疗无神经损伤表现单节段胸腰椎骨质疏松性骨折患者48例,男22例,女26例;年龄55~72岁,平均62.2岁;受伤至手术时间为8 h~9 d,平均4.5 d。依据Denis分型:压缩型35例,爆裂型13例。骨折部位:T_(11)9椎,T_(12)15椎,L_1 14椎,L_2 7椎,L_3 3椎。观察并比较患者手术前后伤椎前缘高度比、矢状面Cobb角、椎体矢状面指数(SI)随访期间内固定失败情况及后凸畸形再发等情况。结果:所有患者获得随访,时间24~48个月,平均32.5个月。手术时间60~140 min,平均85 min;术中出血量50~100 ml,平均为75 ml。术前、术后3 d及术后1年时的伤椎前缘高度比分别为(56.4±2.6)%、(91.2±1.6)%、(86.9±3.2)%;局部后凸矢状面Cobb角分别为(26.6±3.2)°、(6.2±1.0)°、(6.8±1.5)°;SI分别为(51.6±4.2)%、(90.2±5.9)%、(88.7±4.2)%;疼痛视觉模拟评分(visual analogue sacle,VAS)分别为7.6±1.2、2.8±1.9、1.1±0.4。术后3 d较术前明显改善,术后1年与术后3 d比较差异无统计学意义。未发生神经功能损坏、内固定失败及后凸畸形再发。结论:经皮后路短节段椎弓根螺钉固定结合伤椎骨水泥强化治疗单节段胸腰椎骨质疏松性骨折创伤小,同时可有效恢复脊柱正常生理负荷传导,防止内固定失败和椎体再发后凸畸形。

Percutaneous short segment pedicle screw fixation with vertebral augmentation for the treatment of single-level thoracolumbar osteoporosis fracture

Objective: To explore clinical outcomes of percutaneous short segment pedical screw fixation with bone cement augmentation in treating single-level thoracolumbar osteoporotic fracture. Methods: From January 2009 to January 2013, 48 single-level thoracolumbar osteoporotic fracture patients without neurological symptoms were treated with percutaneous short segment pedicle screw fixation with bone cement augmentation. Among them, including 22 males and 26 females aged from 55 to 72 years old with an average of 62.2 years old. The time from injury to operation varied from 8 h to 9 d(mean 4.5 d). According to Denis fracture classification, 35 cases were compression fractures and 13 cases were burst fractures. Nine vertebrae located on T₁₁, 15 vertebrae on T₁₂, 14 vertebrae on L₁, 7 vertebrae on L₂, and 3 vertebrae on L₃. Anterior vertebral body height, sagittal Cobb angle, sagittal index(SI), failure of internal fixation and recurrence of kyphosis were observed before and after operation. Results: All patients were followed up from 24 to 48 months with an average of 32.5 months. Operative time ranged from 60 to 140 min with an average of 85 min;blood loss ranged from 50 to 100 ml with an average of 75 ml. Before operation, at 3 d and 1 year after operation, anterior vertebral body height respectively was (56.4±2.6)% , (91.2±1.6)% and (86.9±3.2)%; sagittal Cobb angle respectively was(26.6±3.2) °, (6.2±1.0)° and(6.8±1.5)°;SI respectively was(51.6±4.2)%, (90.2±5.9)% and (88.7±4.2)%;VAS respectively was(7.6±1.2), (2.8±1.9), (1.1±0.4) points. There were significant differences above items between before operation and at 3 d after operation, while no significance between 1 year and 3 d after operation. No neurologic damage, internal fixation failure and recurrence of kyphosis occurred. Conclusion: Percutaneous short segment pedicle screw fixation with bone cement augmentation in treating single-level thoracolumbar osteoporotic fracture has advantages of less trauma, and could effectively restore normal physiological load transmission of spinal, avoid failure of internal fixation and recurrence of kyphosis.